Addiction, History and Historians: Ron Roizen’s Response to Courtwright’s Reply

Editor’s Note: Let’s face it–there was an awful lot to chew on in the recent roundtable on David Courtwright’s essay. A private exchange between Ron Roizen and David Courtwright has led, with David’s encouragement, to Ron organizing his thoughts as a follow up to David’s reply to our series of commenters.

There’s an echo of Kuhn’s concept of “normal science” in David’s reply – particularly in his optimistic view that future research focused by the “NIDA paradigm” will serve to invite new studies at increasingly complex and interesting levels of inquiry, thus giving rise to new knowledge that might not otherwise have seen the light of day. The main thrust of David’s reply is that a happy co-existence is possible between NIDA’s reductionist paradigm and the anti-reductionist inclinations of many historians and social scientists. We in the “softer sciences,” David suggests, should, where appropriate, make use of the brain disease paradigm’s benefits and then turn to our own disciplinary tool kits when our inquiries require them.

I balk at this position for a number of reasons. First, there is the question of consistency in David’s argument. I was so taken by the following passage in David’s Addiction article that I fired off the full quotation, via email, to Stanton Peele:

The brain-disease paradigm appears to be an old fashioned monistic pathology wearing the fashionable garb of neuroscience [30]. It strikes them [i.e., alcohol and drug historians] (and many other social scientists) as crudely reductive because it ignores that which cannot be illumined with positrons or studied in neurons. It seems irrelevant because it sheds no light on culturally speciﬁc phenomena. It seems threatening because it gains all the funding and media attention. It seems intellectually reactionary because it evokes biological essentialism and naive positivism. It may even be politically reactionary because it lends, inadvertently and despite the medicalizing intentions of its proponents, the prestige of science to supply-side drug warriors bent on keeping everyone’s fragile brains out of the sizzling drug grease [27].

I have a little trouble meshing David’s eloquent statement of reductionism’s pitfalls with the optimistic modus vivendi he’s proposed in his reply to commenters.

Thomas Szasz

The second reason is that I, I confess, have an almost allergic reaction to the radical reductionism of the NIDA paradigm. I think first of Thomas Szasz’s mocking wit: NIDA’s brain disease reductionism, he might have said, is like the guy who responds to a TV program he doesn’t like by calling a TV repairman. That unfortunate TV repairman, in turn, can investigate the electronics of this guy’s TV set until the cows come home and never – and I mean never! – find a clue about why the program the guy disliked got produced, got supported by happy sponsors, or got watched by a big TV audience, etc.

Moreover, consider Alan I. Leshner’s recent comment on the brain disease model’s origins and reason for being at NIDA. He did not invent the brain disease model, wrote Leshner. “But it did resonate with me,” he noted, “and I saw its powerful potential to change the way the public sees addiction and, perhaps, to help reduce the stigma associated with it.” The brain disease idea became “NIDA’s mantra,” Leshner also noted, during his tenure as the institute’s director. (2) Leshner’s candid revelation of the public relations aims behind his use of the NIDA paradigm readily recalled to my mind the unlikely, shaggy-dog story associated with the rise of the disease concept of alcoholism.(3) Now comes along the brain disease of addiction, lagging decades behind the disease alcoholism campaign, the latter also initially promoted for its imputed public relations payoffs. (4)

How much happy co-existence is likely in the research world David has suggested? Even he concedes that the upcoming the NIAAA-NIDA merger may result in a triumph for the NIDA paradigm. If so, counter-reductionist historians and social scientists may find themselves even more out in the cold than they already were before merger. In that case, David’s advice to let a thousand flowers bloom may one day strike some, in retrospect, as a kind of Chamberlain-back-from-Munich misplaced optimism. The problem with brain-disease true believers, moreover — as David has also suggested — is that they tend to be tone deaf to more holistic explanatory perspectives. Also, there is the issue of the relatively high status or prestige accorded neuroscience, prestige that is ostensibly made available via the brain disease model to NIDA’s researchers. What happens in a world where TV repairmen have more status, say, than the writers and producers of TV shows? Will there be Academy Awards and Emmy Awards for TV repairmen and lavish balls – even if the guy sitting at home still doesn’t like what he’s seeing on his TV?

As a sociologist, for me the important questions in the alcohol and drug problem arenas are not those the TV repairman can address. And yet the TV repairman may soon be willy-nilly taking over the government supported drug and alcohol research domain. Of course, the story is more complicated than that. One complicating aspect, for example, concerns the limits of NIH authority regarding irreducibly social or cultural issues. Drug and alcohol research got placed into the “health” rubric in the first place as a kind of self-elevating status move. Neither was first and foremost a health-related public problem. Both, from a social perspective, had much more to do with social order and social control. Maybe therefore NIDA’s paradigm and the NIAAA-NIDA merger initiative together reflect something about that underlying tension. Maybe advocates of the paradigm and the merger are saying, in effect: “We at NIH do health research only and the non-health (or non-involuntary) aspects of the alcohol and drug problems domains therefore must, ipso facto, find a new home somewhere else.” That’s a defensible position for an M.D. at the head of NIH, and yet of course it represents a staggering setback for the prospect of ever gaining a broad and scientifically informed understanding of drug and alcohol problems in American society.

Finally, my most important reservation: I see the rise of the brain disease metaphor, and the rise of the TV repairman, as arguably a kind of ruse being played on the larger society – many among us, after all, actually still believe that “the experts” know something important that will lead us out of the dark forest. It’s that ruse-like aspect of the NIDA paradigm and its current seeming ascendancy that troubles me most of all.

Much as I appreciate and admire David Courtwright’s recent contributions to our understanding of the history and sociology U.S. drug research, I think I’d admire them even more if he took a rather less favorable view of the NIDA paradigm and the direction it’s currently taking us.

Acknowledgment:

Thanks are owed David Courtwright for the academic good sportsmanship he showed in suggesting that my private response should be aired at Points.

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3 Comments

Thanks Ron, as ever a succinct and insightful commentary, which sits well alongside David Courtwright’s recent thoughtful contributions. For those of us who have laboured long attempting to increase our understanding of the complex and at times baffling array of factors which influence our attitudes towards and behaviours with respect to drug use, I for one have become increasingly concerned that the zealous and costly search for the magic gene, coupled with the desire to re-medicalise (using mental illness as the paradigm of choice) the sector, is inevitably doomed to fail as it has in past manifestations.

[…] Points friend and contributor Ron Roizen wrapped up the symposium with a spritely reply to Dr. Courtwright’s reply, which he accompanied with a truly memorable work of outsider art. Lexington Narcotic […]

Australia seems to be taking a slightly different track with its popularization of the ARBI – Alcohol Related Brain Injury – terminology. To use Leshner’s quotes, it has a “… powerful potential to change the way the public sees addiction…”, but “Injury”‘s meaning organic damage, even permanent damage, would seem to make the goal of “…reduc[ing] the stigma associated with it.” more unreachable.